Provider Demographics
NPI:1184172546
Name:BRASS, JILLIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:BRASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1253
Mailing Address - Country:US
Mailing Address - Phone:516-801-5500
Mailing Address - Fax:516-801-5568
Practice Address - Street 1:240 WILLOW ST
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1253
Practice Address - Country:US
Practice Address - Phone:516-801-5500
Practice Address - Fax:516-801-5568
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020236103TS0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical